Why the gloomy claims about BME representation at board level don’t add up

Don’t believe the assertion that diversity on NHS boards is declining, writes WRES director

Don’t believe the assertion that diversity on NHS boards is declining, says NHS England’s director for Workforce Race Equality Standard implementation

Picture: iStock

When it comes to race equality, very few people anywhere in the world can claim they are getting it right. Evidence shows that people from black and minority ethnic (BME) backgrounds are more likely to experience health problems, be less wealthy and generally have poorer life chances.

The NHS is England's biggest employer of people from BME backgrounds – a head count of one in five – yet when it comes to senior positions within organisations, representation, though improving, is poor.

High-level commitment to change

However, there has never been a time when the NHS has taken race equality as seriously as it does now. The high-level support and commitment it receives is evidenced by the investment in the Workforce Race Equality Standard (WRES).

The WRES, which is beginning to show a positive impact, is deeply embedded within the system and policy levers in the health service: within the NHS Standard Contract, the NHS Long Term Plan, the Interim People Plan, and in the Care Quality Commission (CQC) inspection regime. It requires trusts to show progress against a number of indicators that reflect equality for staff.

‘The report’s headline conclusion is completely out of sync with what the WRES data is telling us about the ethnic diversity of NHS boards’

The publication last week of the NHS Confederation report Chairs and Non-Executives in the NHS: The Need for Diverse Leadership caused a stir, but the report does not give a true picture of what is really going on in our NHS today.

Its headline conclusion is that chair and non-executive director roles are becoming less and less diverse. This is completely out of sync with what the WRES data is telling us about the ethnic diversity of boards in the NHS.

More diverse than ever

The NHS workforce as a whole is now more diverse than at any time in its 71-year history, and as the latest WRES data clearly show, board-level diversity is increasing year on year, following the implementation of the WRES. The NHS Confederation report is therefore at odds with the trend – a trend that is based on objective and robust electronic staff records data.

In 2016, there were 16 NHS trusts in England with three or more BME board members; by 2018 this had increased to 29 trusts.

Now in 2019 we have eight NHS trust chief executives of BME background – nearly double the number we had just four years ago – and three more BME executive directors of nursing. BME non-executives in London NHS trusts have increased from 19 in 2015 to 50 in 2019.

Diversity at board level – what the figures show

The most reliable data we have is for 2017 and 2018, when the Workforce Race Equality Standard (WRES) had 100% submission from NHS trusts. This offers the best comparison.

Table 1: NHS Trusts BME board representation as a percentage

BME board members 2017 2018
Non-executive 7.6% 8.0%
Executive 7.0% 7.4%

The proportion of BME executive and non-executive board members both increased by 0.4 percentage points.

Source: WRES submissions 2017 and 2018


Table 2: Number of BME board members on NHS Trusts

BME board members 2017 2018 % increase
Non-executive 116 129 11.2%
Executive 214 226 5.6%

There has been a decrease in the number and proportion of trusts with zero BME representation on the board since 2017. 41.6% (96) of trusts have no BME representation on the board, down from 43.8% (98) from the previous year.

Source: WRES submissions 2017 and 2018


Let’s compare apples with apples

Evidence clearly shows that tackling workforce race inequality improves the experience for staff, leads to better patient outcomes and is associated with organisational efficiency. Since 2014, NHS organisations have been working tirelessly on this agenda, and the national healthcare bodies are, in the main, providing the support and guidance needed to help facilitate improvement.

Contribution to this important agenda is welcomed and encouraged, and collaborative action is essential. Unfortunately, the NHS Confederation report compares apples with pears when describing board representation as going backwards.

‘The NHS, like most other organisations in the country has work to do on this agenda, but I think we can also safely agree that we are not “going backwards”’

For example, the headline 2010 benchmark figures were taken from the Appointments Commission annual accounts and covered a wide range of public sector organisation types, including local NHS organisations, which include (now defunct) primary care trusts, strategic health authorities, national health and social care bodies and other government departments. Historical data for these organisations are then compared with 2017 WRES data that only looks at NHS trusts.

When we compare apples with apples, we find that over time we are making progress on leadership representation – although we still have much more to do, no one is denying that. We have set the NHS and the national healthcare arm’s-length bodies an ambitious challenge of ensuring leadership across the NHS is fully representative of the overall workforce by 2028.

Slow but steady progress

In the recently published Model Employer leadership strategy, we have outlined a comprehensive and holistic set of objectives and interventions to help guide the NHS to achieve this goal. We encourage all staff to read this plan for turbo-boosting BME representation, along with the annual WRES data reports, which present the latest trends on workforce race equality, including leadership representation.

Everyone working in the NHS needs to reflect on what they will do to help deliver on our ambitious objectives. 

We can all agree that the NHS, like most other organisations in the country has work to do on this agenda, but I think we can also safely agree that we are not ‘going backwards’. In fact, the opposite is true; we are making slow, but good progress on this challenging and complex agenda.

Yvonne Coghill is director for WRES implementation, NHS England, and RCN deputy president

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